A schoolgirl's eye condition worsened over two years after a full capacity specialist service resulted in priority appointments falling through the cracks.

August 17, 2018

By: Vaimoana Tapaleao

A schoolgirl’s eye condition worsened over two years after a full capacity specialist service resulted in priority appointments falling through the cracks.

The Health and Disability Commissioner, Anthony Hill, today released a report saying the Counties Manukau District Health Board had been in breach of the code of health and disability services consumers’ rights for failing to provide a timely ophthalmology follow-up to a young girl.

In December 2006, the then 5-year-old was looked at by staff at the Counties Manukau DHB ophthalmology service after suffering eyesight issues from early childhood. She was ordered to wear glasses from then on.

Counties Manukau DHB is having to make changes to its overdue appointments systems.

In June 2012, the youngster was seen by a community optometrist who referred her to the ophthalmology service to check an unexplained reduction in visual acuity in both her eyes.

She arrived for a scheduled specialist appointment later that year, in November, and was diagnosed with possible early fruste from keratoconus – progressive thinning of the cornea.

But a follow-up appointment about a year later, on November 22, did not go ahead.

The girl’s father told the HDC he telephoned the clinic when his daughter was not recalled within the year.

The report says: “He was told something along the lines of ‘we are short-staffed and cannot always make appointments as requested by the team’.”

When informed the appointment did not happen, the family’s GP was also told that the family had tried to arrange one themselves via the outpatient call centre.

Counties Manukau DHB is having to make changes to its overdue appointments systems. The DHB covers areas south of Auckland.

“I recall contacting the eye department myself asking if [my patient] had been lost to follow-up,” the GP said.

“I did not know if [her] issue was still astigmatism, but pointed out the planned follow-up had not occurred.”

The doctor also checked a regional database website – that family doctors can see DHB patients’ results – and saw that an appointment for the girl had been lodged in November 2012 for November 22, 2013, but that there were no notes or other details.

In the report, the district health board’s response was that at the time, there was only one paediatric orthoptist who had a “large and increasing workload”.

It was noted that the planned appointment in 2013 was cancelled. But no reason was entered in the system showing why.

“CMDHB told HDC that the delay in receiving the 12-month follow-up appointment was due to huge demand for the cornea service and a limited anterior segment (front of the eye) and contact lens service at CMDHB.

“The increasing demand on the follow-up cornea service also impacted on the number of patients requiring contact lists.”

The report says the ophthalmology service used an electronic follow-up reporting system to catch overdue appointments. But an “overflow” of follow-up appointments meant all were given the same clinical priority.

The DHB said it posted two letters to the girl’s family. The family said they did not receive them.

It would be two years and nine months after her first appointment at the clinic when the girl would be back. She was diagnosed with keratoconus – a conic protrusion of the cornea.

“Her right eye was very severe and no longer able to receive less invasive treatment,” the report said.

Recommendations:

Hill recommended CMDHB provide the HDC with a detailed report on the steps taken – including relating to its work with the Ministry of Health – to address issues around its technological systems, how it deals with heavy demands and prioritisation of follow-up appointments.

It is also to report back with an independent evaluation of its systems to identify and prioritise overdue ophthalmology patients and the shortcomings of its patient administration system.

“I consider that the Ministry of Health has a role – with DHBs – to recognise the effect of the introduction of such new technologies and associated pressures on the system and plan accordingly.

“However, the existence of systematic pressures does not remove provider accountability in addressing such issues.

“A key improvement that all DHBs and the Ministry of Health must make now – and in the future – is to assess, plan and respond effectively to the foreseeable effects that new technologies and population change will have on systems and demand.”